A short history of prosthetics

Prosthetics have both a practical purpose and an emotional one, with some people feeling that they help to make them whole. In ancient Egypt, there is evidence of a woman with a prosthetic toe that is made from wood and leather and some people say wouldn’t have affected her ability to walk. Those people hypothesise that because they were a sandal wearing culture, she had felt it important to her identity to have the prosthetic. Others believe that it will have contributed to her ability to walk. Either way, I think it’s pretty amazing that we have evidence of prosthetics that old, especially given the materials they were generally made with. In Egypt they were made from fibre and wood and echoed the importance they placed on wholeness.

Another early example is an artificial leg that dates back to about 300 BC. It was found in Italy and was made of bronze and iron with a wooden core. It’s thought this was held in place by a leather belt.

Whilst we tend to think of a prosthesis as replacing a limb, they are used to replace other body parts including eyes, breasts and teeth. And when it comes to teeth we find a lot more literature. Did you know, for example, that at one time hippo ivory was used to make false teeth as it was stronger than alternative ivory and didn’t yellow so quickly.

Etruscan false teeth from between 8th and 3rd century BCE have been discovered as have sets of false teeth which were made from animal teeth or even human teeth and were connected to intact teeth with a metal band. Anyway, I don’t like the dentist and all this talk about teeth is too much for me….

Hook hands, peg legs and iron hands were used from roman times to the end of the middle ages with little advancement in technology. In the 16th century, a hinged arm and a locking leg were invented. The heavy iron was replaced by a mix of leather, paper and glue tanks for a French locksmith of all people. We also have to thank watchmakers for contributing to the development of prosthetics as gears and springs were used and needed a careful approach for the intricate parts.

The history of prosthetics is about the history of the prosthetics of the wealthy, or lucky, as is often the case today. Knights may have been fitted with them because of their status but possibly also because the history of prosthetics has always been intertwined with the history of wars and the soldiers that fight in them. We know of a roman general that lost his hand and couldn’t fight, but with the aid of an iron prosthetic that could hold his shield, he was able to retain his identity as a general and presumably return to war…

Around 1800, a breakthrough was made in the mechanics of prosthetic limbs by James Potts. His ‘Anglesey’ leg had articulated parts and used cat-gut tendons to hinge the knee and ankle, creating a walking motion when the toe was lifted. This design was further developed by adding a heel spring.

The American Civil War saw many many limbs amputated and the US government supplied these soldiers with prosthetics, allowing them to return to work…. So kind! This vastly increased demand and presumably there were tweaks to design at the same time. Midway through the war, a new way of attaching the prosthesis was developed that used suction rather than straps. Another prosthetic that came from the war was a rubber hand which had fingers and was able to connect to an array of attachments.

World War One also saw an increased demand for prosthetics but poor designs and poor fitting led to many going unused. Common complaints included pain related to friction between prosthesis and the amputated limb and the weight of the prosthetic.

Throughout most of history, prosthetic limbs were wood or metal although I read about one that was made from plaster and animal glue and another that was iron with a wooden core. More recently, lighter options have become available. Lightweight aluminium combined with the suction attachment made for more practical and more affordable options and more recently plastics and electronics have followed. Another big change is around the look of them. Historically, prosthetic limbs have been designed to replicate the limb and to make other people feel comfortable but in recent decades, there has been a noticeable move towards function over appearance.

In the 1960s, children affected by thalidomide were born with malformed limbs and technological solutions to medical issues were sought. These came in the form of personalised prosthetics which sped up the advancement of this area. Gas powered prosthetics were invented to help children and whilst they may have sounded great, and certainly I’m sure some kids found them helpful, others found them difficult and cumbersome. They required a lot of time away from home to fit them and teach the children how to use them and this obviously had to be repeated as the child grew. Further, as the child grew up, they wanted to be able to do more with their prosthesis such as feed themselves, write and go to the toilet by themselves. To be able to do these tasks would make mainstream school accessible.

Gas had been chosen as a power source because batteries at that point were impractical. As time went on, other ideas were considered and someone thought that a more modular system might work and by this point technology had shrunk making batteries more practical.

In the 1990s, knees that used computer chips were introduced. The chip controlled the speed and swing of the knee joint and sensors provided feedback. In 1998 the first electric arm was fitted. The i-limb was the first prosthetic to have individually powered fingers and gave the user more control and more feedback. As well as limbs that allow for walking, we have seen limbs that are designed for running and other sports.

Today we are seeing a more personalised approach to prosthetics including the alternative limb project which seeks to go beyond the replacement of a limb and creates imaginative and personalised options.